Download Interim Infection Control and Exposure Management

Interim Infection Control and Exposure Management
Guidance in the Health-Care and Community Setting for
Patients with Possible Monkeypox Virus Infection
The Centers for Disease Control and Prevention (CDC) has received reports of patients with a febrile rash
illness who had direct or close contact with recently purchased ill prairie dogs or Gambian giant rats.
Preliminary results of serologic testing, polymerase-chain-reaction analysis, and gene sequencing
performed at the CDC indicate that the causative agent is monkeypox virus, a member of the
orthopoxvirus group of viruses. CDC is issuing interim guidance concerning infection control precautions
and exposure management in the health-care and community settings. The guidance will be updated as
additional information about the epidemiology of disease transmission is better understood.
Infection Control: General Precautions
Persons seeking medical care with fever or rash should be asked about possible exposure to small
mammals, especially pet prairie dogs and Gambian giant rats. If a patient with suspect monkeypox
infection is seen as an outpatient or admitted to the hospital, infection control personnel should be notified
immediately. A combination of Standard, Contact, and Airborne Precautions
(www.cdc.gov/ncidod/hip/isolat/isolat.htm) should be applied in all health-care settings. These include:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Hand hygiene after all contact with an infected patient and/or the environment of care.
Use of gown and gloves for any contact with the patient and/or the environment of care.
Eye protection (e.g. goggles or face shield) if splash or spray of body fluids is likely.
Respiratory protection including a NIOSH-certified N95 filtering disposable respirator for entering
the room or patient care area.1 If N95 respirators are not available for health-care personnel, then
surgical masks should be worn.
Airborne isolation room with negative pressure relative to the surrounding area. If a negative
pressure room is not available, place the patient in a private room.
Contain and dispose of contaminated waste (e.g., dressings) in accordance with facility-specific
guidelines for infectious waste or local regulations pertaining to household waste.
Use care when handling soiled laundry (e.g., bedding, towels, personal clothing) to avoid contact
with lesion exudates. Soiled laundry should not be shaken or otherwise handled in a manner that
may aerosolize infectious particles.
Handle used patient-care equipment in a manner that prevents contamination of skin and clothing.
Ensure that used equipment has been cleaned and reprocessed appropriately.
Ensure that procedures are in place for cleaning and disinfecting environmental surfaces in the
patient care environment. Any EPA-registered hospital detergent-disinfectant currently used by
health-care facilities for environmental sanitation may be used. Manufacturer’s recommendations
for use-dilution (i.e., concentration), contact time and care in handling should be followed.
1
Respirators should be used in the context of a complete respiratory protection program in accordance with OSHA regulations. This
includes training and fit testing to ensure a proper seal between the respirator’s sealing surface and the wearer’s face. Detailed
information on respirator programs, including fit test procedures, can be accessed at www.osha.gov/sltc/etools/respiratory. Where
possible, a qualitative fit test should be conducted for N95 respirators; detailed information on fit testing can be accessed at
www.osha.gov/sltc/etools/respiratory/oshafiles/fittesting1.html.
June 9, 2003
Page 1 of 3
Interim Infection Control and Exposure Management Guidance in the Health-Care and
Community Setting for Patients with Possible Monkeypox Virus Infection
(continued from previous page)
Infection Control: Outpatient Management
Segregate the patient from others in the reception area as soon as possible, preferably in a private room
with negative pressure relative to the surrounding area. Place a surgical mask over the patient’s nose and
mouth. Care should be taken to cover exposed skin lesions (sheet and/or gown on patient) to prevent
contact with infectious material.
Monitoring of Exposed Health-care Personnel
Health-care workers who have unprotected exposures to patients with monkeypox need not be excluded
from duty, but should undergo active surveillance for symptoms, including measurement of body
temperature at least twice daily for 21 days following the exposure. Prior to reporting for duty each day,
the health-care worker should be interviewed regarding symptoms and have their temperature measured
by employee health or other designee.
Health-care workers who have cared for or otherwise been exposed to monkeypox patients while adhering
to recommended infection control precautions should be instructed to be vigilant for fever and other
symptoms, including measurement of body temperature at least twice daily for 21 days following the last
exposure to a monkeypox patient. These health-care workers should be contacted by occupational health,
infection control or their designee regularly over the 21-day period following exposure to inquire about
fever or other symptoms.
Home Management
1. Home isolation
a. Patients who do not require hospitalization for medical indications may be isolated at home.
Persons with extensive lesions that cannot be easily covered (excluding facial lesions) or
draining/weeping lesions or respiratory symptoms (e.g., cough, sore throat, or rhinorrhea)
should be isolated in a room or area separate from other family members when possible. For
movement outside the isolation area, a surgical mask should be worn if respiratory symptoms
are present.
b. Skin lesions should be covered to the extent possible (e.g., long sleeves, long pants) to
minimize risk of contact with others.
c. Family members who enter the room or area should wear a surgical mask that fits snugly;
disposable gloves should be worn for direct contact with the patient.
d. Unexposed persons should not enter the home. Health-care personnel and others who must
enter the home to provide patient-related services should wear an N95 respirator.
2. Hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) should
be performed by infected persons and household contacts frequently, and particularly after
touching body sites, clothing, linens, or environmental surfaces that may have had contact with
infectious lesions.
3. Laundry (e.g., bedding, towels, clothing) may be washed in a standard washing machine with
warm water and detergent; bleach may be added but is not necessary. Care should be used when
handling soiled laundry to avoid direct contact with contaminated material. Soiled laundry should
not be shaken or otherwise handled in a manner that may aerosolize infectious particles.
4. Dishes and other eating utensils should not be shared but segregations of specific utensils for use
by the infected person is not necessary. Soiled dishes and eating utensils should be washed with
warm water and soap.
5. Contaminated surfaces should be cleaned and disinfected. Standard household
cleaning/disinfectants may be used in accordance with manufacturer’s instructions.
June 9, 2003
Page 2 of 3
Interim Infection Control and Exposure Management Guidance in the Health-Care and
Community Setting for Patients with Possible Monkeypox Virus Infection
(continued from previous page)
6. Dressing, bandages, and other materials contaminated with lesion drainage should be bagged and
placed in another container for disposal with other household waste.
Duration of Isolation Precautions
Isolation precautions, either in health-care facilities or home settings, should be continued until all lesions
are crusted.
Asymptomatic Contacts
Asymptomatic contacts to animals or humans suspected to have monkeypox must be placed under
symptom surveillance for 21 days after their last exposure. Symptoms of concern include fever
(temperature > 100.5°F), sore throat, cough, or skin rash.
Asymptomatic contacts may continue routine daily activities (e.g., go to work, school) but should remain
close to home for the duration of surveillance. However, it may be prudent to exclude pre-school children
from daycare or other group settings.
Contacts must monitor their temperature twice daily. In addition, they must maintain daily telephone
contact with designated health department personnel. If resources permit, closer monitoring is desirable.
For more information, visit www.cdc.gov/ncidod/monkeypox or call the CDC public response hotline
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY)
June 9, 2003
Page 3 of 3